Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes

Key Points

  • 20–40% of patients with IBD in Western countries are obese

  • Premorbid obesity, in particular visceral adiposity, might increase the risk of developing Crohn's disease

  • Obesity might contribute to the pathogenesis of IBD through dysbiosis, mucosal barrier dysfunction with bacterial translocation and activation of adipocytes

  • Risk of complications, such as surgery, hospitalization and infection, might be increased in patients with IBD who are obese

  • Obesity is associated with rapid clearance of biologic agents, resulting in low trough concentrations, and could result in suboptimal response to biologics

  • Treating obesity could be a potential adjunct therapeutic target in patients with IBD who are obese


Incidence of IBD is rising in parallel with overweight and obesity. Contrary to conventional belief, about 15–40% of patients with IBD are obese, which might contribute to the development of IBD. Findings from cross-sectional and retrospective cohort studies are conflicting on the effect of obesity on natural history and course of IBD. Most studies are limited by small sample size, low event rates, non-validated assessment of disease activity and lack robust longitudinal follow-up and have incomplete adjustment for confounding factors. The effect of obesity on the efficacy of IBD-related therapy remains to be studied, though data from other autoimmune diseases suggests that obesity results in suboptimal response to therapy, potentially by promoting rapid clearance of biologic agents leading to low trough concentrations. These data provide a rationale for using weight loss interventions as adjunctive therapy in patients with IBD who are obese. Obesity also makes colorectal surgery technically challenging and might increase the risk of perioperative complications. In this Review, we highlight the existing literature on the epidemiology of obesity in IBD, discuss its plausible role in disease pathogenesis and effect on disease course and treatment response, and identify high-priority areas of future research.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1: Association between premorbid obesity, waist–hip ratio and weight gain since age 18 years and IBD risk.
Figure 2: Postulated pathogenesis and feedback loop between visceral adipose tissue and intestinal inflammation in IBD.


  1. 1

    Ng, M. et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384, 766–781 (2014).

    PubMed  PubMed Central  Google Scholar 

  2. 2

    Finkelstein, E. A., Trogdon, J. G., Cohen, J. W. & Dietz, W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff. 28, w822–w831 (2009).

    Google Scholar 

  3. 3

    Molodecky, N. A. et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142, 46–54 (2012).

    PubMed  Google Scholar 

  4. 4

    Ng, S. C. et al. Early course of inflammatory bowel disease in a population-based inception cohort study from 8 countries in Asia and Australia. Gastroenterology 150, 86–95. e3 (2016).

    PubMed  Google Scholar 

  5. 5

    Kaplan, G. G. The global burden of IBD: from 2015 to 2025. Nat. Rev. Gastroenterol. Hepatol. 12, 720–727 (2015).

    PubMed  Google Scholar 

  6. 6

    Qin, B. et al. Body mass index and the risk of rheumatoid arthritis: a systematic review and dose-response meta-analysis. Arthritis Res. Ther. 17, 86 (2015).

    PubMed  PubMed Central  Google Scholar 

  7. 7

    Sterry, W., Strober, B. E., Menter, A. & International Psoriasis Council. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review. Br. J. Dermatol. 157, 649–655 (2007).

    CAS  PubMed  Google Scholar 

  8. 8

    Flores, A., Burstein, E., Cipher, D. J. & Feagins, L. A. Obesity in inflammatory bowel disease: a marker of less severe disease. Dig. Dis. Sci. 60, 2436–2445 (2015).

    CAS  PubMed  Google Scholar 

  9. 9

    Long, M. D. et al. Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm. Bowel Dis. 17, 2162–2168 (2011).

    PubMed  Google Scholar 

  10. 10

    Pringle, P. L. et al. Body mass index, genetic susceptibility, and risk of complications among individuals with Crohn's disease. Inflamm. Bowel Dis. 21, 2304–2310 (2015).

    PubMed  PubMed Central  Google Scholar 

  11. 11

    Mendall, M. A., Gunasekera, A. V., John, B. J. & Kumar, D. Is obesity a risk factor for Crohn's disease? Dig. Dis. Sci. 56, 837–844 (2011).

    CAS  PubMed  Google Scholar 

  12. 12

    Seminerio, J. L. et al. Impact of obesity on the management and clinical course of patients with inflammatory bowel disease. Inflamm. Bowel Dis. 21, 2857–2863 (2015).

    PubMed  Google Scholar 

  13. 13

    Nic Suibhne, T. et al. High prevalence of overweight and obesity in adults with Crohn's disease: associations with disease and lifestyle factors. J. Crohns Colitis 7, e241–e248 (2013).

    PubMed  Google Scholar 

  14. 14

    Stabroth-Akil, D., Leifeld, L., Pfutzer, R., Morgenstern, J. & Kruis, W. The effect of body weight on the severity and clinical course of ulcerative colitis. Int. J. Colorectal Dis. 30, 237–242 (2015).

    PubMed  Google Scholar 

  15. 15

    Steed, H., Walsh, S. & Reynolds, N. A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside, Scotland. Obes. Facts 2, 370–372 (2009).

    PubMed  PubMed Central  Google Scholar 

  16. 16

    Kugathasan, S. et al. Body mass index in children with newly diagnosed inflammatory bowel disease: observations from two multicenter North American inception cohorts. J. Pediatr. 151, 523–527 (2007).

    PubMed  Google Scholar 

  17. 17

    Blain, A. et al. Crohn's disease clinical course and severity in obese patients. Clin. Nutr. 21, 51–57 (2002).

    CAS  PubMed  Google Scholar 

  18. 18

    Moran, G. W., Dubeau, M.-F., Kaplan, G. G., Panaccione, R. & Ghosh, S. The increasing weight of Crohn's disease subjects in clinical trials: a hypothesis-generatings time-trend analysis. Inflamm. Bowel Dis. 19, 2949–2956 (2013).

    PubMed  Google Scholar 

  19. 19

    Khalili, H. et al. Measures of obesity and risk of Crohn's disease and ulcerative colitis. Inflamm. Bowel Dis. 21, 361–368 (2015).

    PubMed  PubMed Central  Google Scholar 

  20. 20

    Harpsoe, M. C. et al. Body mass index and risk of autoimmune diseases: a study within the Danish National Birth Cohort. Int. J. Epidemiol. 43, 843–855 (2014).

    PubMed  Google Scholar 

  21. 21

    Chan, S. S. M. et al. Body mass index and the risk for Crohn's disease and ulcerative colitis: data from a European Prospective Cohort Study (The IBD in EPIC Study). Am. J. Gastroenterol. 108, 575–582 (2013).

    PubMed  Google Scholar 

  22. 22

    Hemminki, K., Li, X., Sundquist, J. & Sundquist, K. Risk of asthma and autoimmune diseases and related conditions in patients hospitalized for obesity. Ann. Med. 44, 289–295 (2012).

    PubMed  Google Scholar 

  23. 23

    Kredel, L. I. & Siegmund, B. Adipose-tissue and intestinal inflammation — visceral obesity and creeping fat. Front. Immunol. 5, 462 (2014).

    PubMed  PubMed Central  Google Scholar 

  24. 24

    Uko, V. et al. Impact of abdominal visceral adipose tissue on disease outcome in pediatric Crohn's disease. Inflamm. Bowel Dis. 20, 2286–2291 (2014).

    PubMed  Google Scholar 

  25. 25

    Khalili, H. et al. Physical activity and risk of inflammatory bowel disease: prospective study from the Nurses' Health Study cohorts. BMJ 347, f6633 (2013).

    PubMed  PubMed Central  Google Scholar 

  26. 26

    Bilski, J., Brzozowski, B., Mazur-Bialy, A., Sliwowski, Z. & Brzozowski, T. The role of physical exercise in inflammatory bowel disease. Biomed. Res. Int. 2014, 429031 (2014).

    PubMed  PubMed Central  Google Scholar 

  27. 27

    Zietek, T. & Rath, E. Inflammation meets metabolic disease: gut feeling mediated by GLP-1. Front. Immunol. 7, 154 (2016).

    PubMed  PubMed Central  Google Scholar 

  28. 28

    Karmiris, K. et al. Circulating levels of leptin, adiponectin, resistin, and ghrelin in inflammatory bowel disease. Inflamm. Bowel Dis. 12, 100–105 (2006).

    PubMed  Google Scholar 

  29. 29

    Tian, J., Venn, A., Otahal, P. & Gall, S. The association between quitting smoking and weight gain: a systemic review and meta-analysis of prospective cohort studies. Obes. Rev. 16, 883–901 (2015).

    CAS  PubMed  Google Scholar 

  30. 30

    Berthon, B. S., MacDonald-Wicks, L. K. & Wood, L. G. A systematic review of the effect of oral glucocorticoids on energy intake, appetite, and body weight in humans. Nutr. Res. 34, 179–190 (2014).

    CAS  PubMed  Google Scholar 

  31. 31

    Wung, P. K. et al. Effects of glucocorticoids on weight change during the treatment of Wegener's granulomatosis. Arthritis Rheum. 59, 746–753 (2008).

    PubMed  PubMed Central  Google Scholar 

  32. 32

    Winer, D. A., Luck, H., Tsai, S. & Winer, S. The intestinal immune system in obesity and insulin resistance. Cell Metab. 23, 413–426 (2016).

    CAS  PubMed  Google Scholar 

  33. 33

    Balistreri, C. R., Caruso, C. & Candore, G. The role of adipose tissue and adipokines in obesity-related inflammatory diseases. Mediators Inflamm. 2010, 802078 (2010).

    PubMed  PubMed Central  Google Scholar 

  34. 34

    Olefsky, J. M. & Glass, C. K. Macrophages, inflammation, and insulin resistance. Annu. Rev. Physiol. 72, 219–246 (2010).

    CAS  PubMed  Google Scholar 

  35. 35

    Kredel, L., Batra, A. & Siegmund, B. Role of fat and adipokines in intestinal inflammation. Curr. Opin. Gastroenterol. 30, 559–565 (2014).

    CAS  PubMed  Google Scholar 

  36. 36

    Zulian, A. et al. Visceral adipocytes: old actors in obesity and new protagonists in Crohn's disease? Gut 61, 86–94 (2012).

    CAS  PubMed  Google Scholar 

  37. 37

    Batra, A., Zeitz, M. & Siegmund, B. Adipokine signaling in inflammatory bowel disease. Inflamm. Bowel Dis. 15, 1897–1905 (2009).

    CAS  PubMed  Google Scholar 

  38. 38

    Dulai, P. S., Levesque, B. G., Feagan, B. G., D'Haens, G. & Sandborn, W. J. Assessment of mucosal healing in inflammatory bowel disease: review. Gastrointest. Endosc. 82, 246–255 (2015).

    PubMed  PubMed Central  Google Scholar 

  39. 39

    Ouchi, N., Parker, J. L., Lugus, J. J. & Walsh, K. Adipokines in inflammation and metabolic disease. Nat. Rev. Immunol. 11, 85–97 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  40. 40

    Trayhurn, P. & Wood, I. S. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br. J. Nutr. 92, 347–355 (2004).

    CAS  PubMed  Google Scholar 

  41. 41

    Schaffler, A., Scholmerich, J. & Salzberger, B. Adipose tissue as an immunological organ: Toll-like receptors, C1q/TNFs and CTRPs. Trends Immunol. 28, 393–399 (2007).

    CAS  PubMed  Google Scholar 

  42. 42

    Stroh, T. et al. Nucleotide oligomerization domains 1 and 2: regulation of expression and function in preadipocytes. J. Immunol. 181, 3620–3627 (2008).

    CAS  PubMed  Google Scholar 

  43. 43

    Charriere, G. et al. Preadipocyte conversion to macrophage: evidence of plasticity. J. Biol. Chem. 278, 9850–9855 (2003).

    CAS  PubMed  Google Scholar 

  44. 44

    Desreumaux, P. et al. Inflammatory alterations in mesenteric adipose tissue in Crohn's disease. Gastroenterology 117, 73–81 (1999).

    CAS  PubMed  Google Scholar 

  45. 45

    Paul, G. et al. Profiling adipocytokine secretion from creeping fat in Crohn's disease. Inflamm. Bowel Dis. 12, 471–477 (2006).

    PubMed  Google Scholar 

  46. 46

    La Cava, A. & Matarese, G. The weight of leptin in immunity. Nat. Rev. Immunol. 4, 371–379 (2004).

    CAS  PubMed  Google Scholar 

  47. 47

    Batra, A. et al. Leptin: a critical regulator of CD4+ T-cell polarization in vitro and in vivo. Endocrinology 151, 56–62 (2010).

    CAS  PubMed  Google Scholar 

  48. 48

    Siegmund, B., Lehr, H. A. & Fantuzzi, G. Leptin: a pivotal mediator of intestinal inflammation in mice. Gastroenterology 122, 2011–2025 (2002).

    CAS  PubMed  Google Scholar 

  49. 49

    Nishihara, T. et al. Effect of adiponectin on murine colitis induced by dextran sulfate sodium. Gastroenterology 131, 853–861 (2006).

    CAS  PubMed  Google Scholar 

  50. 50

    Fayad, R. et al. Adiponectin deficiency protects mice from chemically induced colonic inflammation. Gastroenterology 132, 601–614 (2007).

    CAS  PubMed  Google Scholar 

  51. 51

    Ohashi, K. et al. Adiponectin promotes macrophage polarization toward an anti-inflammatory phenotype. J. Biol. Chem. 285, 6153–6160 (2010).

    CAS  PubMed  Google Scholar 

  52. 52

    Ogunwobi, O. O. & Beales, I. L. Adiponectin stimulates proliferation and cytokine secretion in colonic epithelial cells. Regul. Pept. 134, 105–113 (2006).

    CAS  PubMed  Google Scholar 

  53. 53

    Schaffler, A. & Scholmerich, J. The role of adiponectin in inflammatory gastrointestinal diseases. Gut 58, 317–322 (2009).

    PubMed  Google Scholar 

  54. 54

    Bokarewa, M., Nagaev, I., Dahlberg, L., Smith, U. & Tarkowski, A. Resistin, an adipokine with potent proinflammatory properties. J. Immunol. 174, 5789–5795 (2005).

    CAS  PubMed  Google Scholar 

  55. 55

    Konrad, A. et al. Resistin is an inflammatory marker of inflammatory bowel disease in humans. Eur. J. Gastroenterol. Hepatol. 19, 1070–1074 (2007).

    CAS  PubMed  Google Scholar 

  56. 56

    Sideri, A. et al. Effects of obesity on severity of colitis and cytokine expression in mouse mesenteric fat. Potential role of adiponectin receptor 1. Am. J. Physiol. Gastrointest. Liver Physiol. 308, G591–G604 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  57. 57

    Zulian, A. et al. Differences in visceral fat and fat bacterial colonization between ulcerative colitis and Crohn's disease. An in vivo and in vitro study. PLoS ONE 8, e78495 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  58. 58

    Peyrin-Biroulet, L. et al. Mesenteric fat as a source of C reactive protein and as a target for bacterial translocation in Crohn's disease. Gut 61, 78–85 (2012).

    CAS  PubMed  Google Scholar 

  59. 59

    Yamamoto, K. et al. Production of adiponectin, an anti-inflammatory protein, in mesenteric adipose tissue in Crohn's disease. Gut 54, 789–796 (2005).

    CAS  PubMed  PubMed Central  Google Scholar 

  60. 60

    Sheehan, A. L., Warren, B. F., Gear, M. W. & Shepherd, N. A. Fat-wrapping in Crohn's disease: pathological basis and relevance to surgical practice. Br. J. Surg. 79, 955–958 (1992).

    CAS  PubMed  Google Scholar 

  61. 61

    Kim, A. Dysbiosis: a review highlighting obesity and inflammatory bowel disease. J. Clin. Gastroenterol. 49 (Suppl. 1), S20–S24 (2015).

    CAS  PubMed  Google Scholar 

  62. 62

    Worthington, J. J. The intestinal immunoendocrine axis: novel cross-talk between enteroendocrine cells and the immune system during infection and inflammatory disease. Biochem. Soc. Trans. 43, 727–733 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  63. 63

    Cani, P. D., Everard, A. & Duparc, T. Gut microbiota, enteroendocrine functions and metabolism. Curr. Opin. Pharmacol. 13, 935–940 (2013).

    CAS  PubMed  Google Scholar 

  64. 64

    Leone, V. A., Cham, C. M. & Chang, E. B. Diet, gut microbes, and genetics in immune function: can we leverage our current knowledge to achieve better outcomes in inflammatory bowel diseases? Curr. Opin. Immunol. 31, 16–23 (2014).

    CAS  PubMed  Google Scholar 

  65. 65

    Lee, D. et al. Diet in the pathogenesis and treatment of inflammatory bowel diseases. Gastroenterology 148, 1087–1106 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  66. 66

    Gruber, L. et al. High fat diet accelerates pathogenesis of murine Crohn's disease-like ileitis independently of obesity. PLoS ONE 8, e71661 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  67. 67

    Hou, J. K., Abraham, B. & El-Serag, H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am. J. Gastroenterol. 106, 563–573 (2011).

    CAS  PubMed  Google Scholar 

  68. 68

    Rioux, J. D. et al. Genome-wide association study identifies new susceptibility loci for Crohn disease and implicates autophagy in disease pathogenesis. Nat. Genet. 39, 596–604 (2007).

    CAS  PubMed  PubMed Central  Google Scholar 

  69. 69

    Sakiyama, T., Fujita, H. & Tsubouchi, H. Autoantibodies against ubiquitination factor E4A (UBE4A) are associated with severity of Crohn's disease. Inflamm. Bowel Dis. 14, 310–317 (2008).

    PubMed  Google Scholar 

  70. 70

    Harrison, E., Lal, S. & McLaughlin, J. T. Enteroendocrine cells in gastrointestinal pathophysiology. Curr. Opin. Pharmacol. 13, 941–945 (2013).

    CAS  PubMed  Google Scholar 

  71. 71

    Qi, K. K., Wu, J., Wan, J., Men, X. M. & Xu, Z. W. Purified PEGylated porcine glucagon-like peptide-2 reduces the severity of colonic injury in a murine model of experimental colitis. Peptides 52, 11–18 (2014).

    CAS  PubMed  Google Scholar 

  72. 72

    Blonski, W., Buchner, A. M., Aberra, F. & Lichtenstein, G. Teduglutide in Crohn's disease. Expert Opin. Biol. Ther. 13, 1207–1214 (2013).

    CAS  PubMed  Google Scholar 

  73. 73

    Moran, G. W., Leslie, F. C. & McLaughlin, J. T. Crohn's disease affecting the small bowel is associated with reduced appetite and elevated levels of circulating gut peptides. Clin. Nutr. 32, 404–411 (2013).

    CAS  PubMed  Google Scholar 

  74. 74

    Friedrich, M., Diegelmann, J., Schauber, J., Auernhammer, C. J. & Brand, S. Intestinal neuroendocrine cells and goblet cells are mediators of IL-17A-amplified epithelial IL-17C production in human inflammatory bowel disease. Mucosal Immunol. 8, 943–958 (2015).

    CAS  PubMed  Google Scholar 

  75. 75

    Iannone, F. et al. Impact of obesity on the clinical outcome of rheumatologic patients in biotherapy. Autoimmun. Rev. 15, 447–450 (2016).

    PubMed  Google Scholar 

  76. 76

    Versini, M., Jeandel, P.-Y., Rosenthal, E. & Shoenfeld, Y. Obesity in autoimmune diseases: not a passive bystander. Autoimmun. Rev. 13, 981–1000 (2014).

    CAS  PubMed  Google Scholar 

  77. 77

    Hass, D. J., Brensinger, C. M., Lewis, J. D. & Lichtenstein, G. R. The impact of increased body mass index on the clinical course of Crohn's disease. Clin. Gastroenterol. Hepatol. 4, 482–488 (2006).

    PubMed  Google Scholar 

  78. 78

    Singh, S., Khera, R. & Sandborn, W. J. Obesity is associated with worse outcomes in hospitalized patients with inflammatory bowel diseases: a nationwide study. Am J Gastroenterol. 111, S271 (2016).

    Google Scholar 

  79. 79

    Erhayiem, B., Dhingsa, R., Hawkey, C. J. & Subramanian, V. Ratio of visceral to subcutaneous fat area is a biomarker of complicated Crohn's disease. Clin. Gastroenterol. Hepatol. 9, 684–687. e1 (2011).

    PubMed  Google Scholar 

  80. 80

    Li, Y. et al. Visceral fat area is associated with a high risk for early postoperative recurrence in Crohn's disease. Colorectal Dis. 17, 225–234 (2015).

    CAS  PubMed  Google Scholar 

  81. 81

    Fitzmorris, P. S. et al. Impact of metabolic syndrome on the hospitalization rate of Crohn's disease patients seen at a tertiary care center: a retrospective cohort study. Digestion 91, 257–262 (2015).

    CAS  PubMed  Google Scholar 

  82. 82

    Harper, J. W., Welch, M. P., Sinanan, M. N., Wahbeh, G. T. & Lee, S. D. Co-morbid diabetes in patients with Crohn's disease predicts a greater need for surgical intervention. Aliment. Pharmacol. Ther. 35, 126–132 (2012).

    CAS  PubMed  Google Scholar 

  83. 83

    Dutton, G. R. et al. 25-year weight gain in a racially balanced sample of U.S. adults: The CARDIA study. Obesity. 24, 19620–1968 (2016).

    Google Scholar 

  84. 84

    Singh, S. et al. Comparative effectiveness and safety of anti-tumor necrosis factor agents in biologic-naive patients with Crohn's disease. Clin. Gastroenterol. Hepatol. 14, 1120–1129. e6 (2016).

    CAS  PubMed  PubMed Central  Google Scholar 

  85. 85

    Osterman, M. T. et al. Comparative effectiveness of infliximab and adalimumab for Crohn's disease. Clin. Gastroenterol. Hepatol. 12, 811–817. e3 (2014).

    CAS  PubMed  Google Scholar 

  86. 86

    Singh, S. et al. Comparative efficacy of biologic therapy in biologic-naive patients with Crohn disease: a systematic review and network meta-analysis. Mayo Clin. Proc. 89, 1621–1635 (2014).

    PubMed  Google Scholar 

  87. 87

    Bhalme, M., Sharma, A., Keld, R., Willert, R. & Campbell, S. Does weight-adjusted anti-tumour necrosis factor treatment favour obese patients with Crohn's disease? Eur. J. Gastroenterol. Hepatol. 25, 543–549 (2013).

    CAS  PubMed  Google Scholar 

  88. 88

    Puig, L. Obesity and psoriasis: body weight and body mass index influence the response to biological treatment. J. Eur. Acad. Dermatol. Venereol. 25, 1007–1011 (2011).

    CAS  PubMed  Google Scholar 

  89. 89

    Dotan, I. et al. Patient factors that increase infliximab clearance and shorten half-life in inflammatory bowel disease: a population pharmacokinetic study. Inflamm. Bowel Dis. 20, 2247–2259 (2014).

    Article  Google Scholar 

  90. 90

    Sharma, S. et al. Pharmacokinetics and exposure-efficacy relationship of adalimumab in pediatric patients with moderate to severe Crohn's disease: results from a randomized, multicenter, phase-3 study. Inflamm. Bowel Dis. 21, 783–792 (2015).

    PubMed  Google Scholar 

  91. 91

    Colombel, J. F. et al. Association between plasma concentrations of certolizumab pegol and endoscopic outcomes of patients with Crohn's disease. Clin. Gastroenterol. Hepatol. 12, 423–431. e1 (2014).

    CAS  PubMed  Google Scholar 

  92. 92

    Xu, Z. H. et al. Population pharmacokinetics of golimumab in patients with ankylosing spondylitis: impact of body weight and immunogenicity. Int. J. Clin. Pharmacol. Ther. 48, 596–607 (2010).

    CAS  PubMed  Google Scholar 

  93. 93

    Rosario, M. et al. Population pharmacokinetics-pharmacodynamics of vedolizumab in patients with ulcerative colitis and Crohn's disease. Aliment. Pharmacol. Ther. 42, 188–202 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  94. 94

    Brill, M. J. et al. Impact of obesity on drug metabolism and elimination in adults and children. Clin. Pharmacokinet. 51, 277–304 (2012).

    CAS  PubMed  Google Scholar 

  95. 95

    Harper, J. W., Sinanan, M. N. & Zisman, T. L. Increased body mass index is associated with earlier time to loss of response to infliximab in patients with inflammatory bowel disease. Inflamm. Bowel Dis. 19, 2118–2124 (2013).

    PubMed  Google Scholar 

  96. 96

    Bultman, E. et al. Predictors of dose escalation of adalimumab in a prospective cohort of Crohn's disease patients. Aliment. Pharmacol. Ther. 35, 335–341 (2012).

    CAS  PubMed  Google Scholar 

  97. 97

    Bond, A. et al. Comparative analysis of the influence of clinical factors including BMI on adalimumab and infliximab trough levels. Eur. J. Gastroenterol. Hepatol. 28, 271–276 (2016).

    CAS  PubMed  Google Scholar 

  98. 98

    Klaasen, R., Wijbrandts, C. A., Gerlag, D. M. & Tak, P. P. Body mass index and clinical response to infliximab in rheumatoid arthritis. Arthritis Rheum. 63, 359–364 (2011).

    CAS  PubMed  Google Scholar 

  99. 99

    Gremese, E. et al. Obesity and reduction of the response rate to anti-tumor necrosis factor α in rheumatoid arthritis: an approach to a personalized medicine. Arthritis Care Res. 65, 94–100 (2013).

    CAS  Google Scholar 

  100. 100

    Eder, L., Thavaneswaran, A., Chandran, V., Cook, R. J. & Gladman, D. D. Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis. Ann. Rheum. Dis. 74, 813–817 (2015).

    PubMed  Google Scholar 

  101. 101

    Poon, S. S. et al. Body mass index and smoking affect thioguanine nucleotide levels in inflammatory bowel disease. J. Crohns Colitis 9, 640–646 (2015).

    PubMed  Google Scholar 

  102. 102

    Boutros, M. & Maron, D. Inflammatory bowel disease in the obese patient. Clin. Colon Rectal Surg. 24, 244–252 (2011).

    PubMed  PubMed Central  Google Scholar 

  103. 103

    Makino, T., Shukla, P. J., Rubino, F. & Milsom, J. W. The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann. Surg. 255, 228–236 (2012).

    PubMed  Google Scholar 

  104. 104

    Hussan, H. et al. Morbid obesity is associated with increased mortality, surgical complications, and incremental health care utilization in the peri-operative period of colorectal cancer surgery. World J. Surg. 40, 987–994 (2016).

    PubMed  Google Scholar 

  105. 105

    Jain, A., Limketkai, B. N. & Hutfless, S. The effect of obesity on post-surgical complications during hospitalizations for inflammatory bowel disease: a nationwide analysis. Gastroenterology 146, S595–S596 (2014).

    Google Scholar 

  106. 106

    Duchesne, J. C., Wang, Y. Z., Weintraub, S. L., Boyle, M. & Hunt, J. P. Stoma complications: a multivariate analysis. Am. Surg. 68, 961–966 (2002).

    PubMed  Google Scholar 

  107. 107

    Beck, S. J. Stoma issues in the obese patient. Clin. Colon Rectal Surg. 24, 259–262 (2011).

    PubMed  PubMed Central  Google Scholar 

  108. 108

    Klos, C. L. et al. Obesity increases risk for pouch-related complications following restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). J. Gastrointest. Surg. 18, 573–579 (2014).

    PubMed  Google Scholar 

  109. 109

    Kiran, R. P. et al. Complications and functional results after ileoanal pouch formation in obese patients. J. Gastrointest. Surg. 12, 668–674 (2008).

    CAS  PubMed  Google Scholar 

  110. 110

    Stidham, R. W. et al. Body fat composition assessment using analytic morphomics predicts infectious complications after bowel resection in Crohn's disease. Inflamm. Bowel Dis. 21, 1306–1313 (2015).

    PubMed  PubMed Central  Google Scholar 

  111. 111

    Ding, Z. et al. Association between high visceral fat area and postoperative complications in patients with Crohn's disease following primary surgery. Colorectal Dis. 18, 163–172 (2016).

    CAS  PubMed  Google Scholar 

  112. 112

    Carucci, L. R. Imaging obese patients: problems and solutions. Abdom. Imaging 38, 630–646 (2013).

    PubMed  Google Scholar 

  113. 113

    Upala, S. & Sanguankeo, A. Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis. Int. J. Obes. 39, 1197–1202 (2015).

    CAS  Google Scholar 

  114. 114

    Di Minno, M. N. et al. Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor α blockers. Ann. Rheum. Dis. 73, 1157–1162 (2014).

    CAS  PubMed  Google Scholar 

  115. 115

    Colombo, F. et al. Bariatric surgery in patients with inflammatory bowel disease: an accessible path? Report of a case series and review of the literature. J. Crohns Colitis 9, 185–190 (2015).

    PubMed  Google Scholar 

  116. 116

    Aminian, A. et al. Outcomes of bariatric surgery in patients with inflammatory bowel disease. Obes. Surg. 26, 1186–1190 (2016).

    PubMed  Google Scholar 

  117. 117

    Johnston, B. C. et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA 312, 923–933 (2014).

    PubMed  Google Scholar 

  118. 118

    Khera, R. et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA 315, 2424–2434 (2016).

    CAS  PubMed  PubMed Central  Google Scholar 

  119. 119

    Dudley, J. T. et al. Computational repositioning of the anticonvulsant topiramate for inflammatory bowel disease. Sci. Transl. Med. 3, 96ra76. (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  120. 120

    Takayanagi, Y. et al. Norepinephrine suppresses IFN-gamma and TNF-alpha production by murine intestinal intraepithelial lymphocytes via the beta(1) adrenoceptor. J. Neuroimmunol. 245, 66–74 (2012).

    CAS  PubMed  Google Scholar 

  121. 121

    Smith, J. P. et al. Therapy with the opioid antagonist naltrexone promotes mucosal healing in active Crohn's disease: a randomized placebo-controlled trial. Dig. Dis. Sci. 56, 2088–2097 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  122. 122

    Brustolim, D., Ribeiro- dos-Santos, R., Kast, R. E., Altschuler, E. L. & Soares, M. B. A new chapter opens in anti-inflammatory treatments: the antidepressant bupropion lowers production of tumor necrosis factor-alpha and interferon-gamma in mice. Int. Immunopharmacol. 6, 903–907 (2006).

    CAS  PubMed  Google Scholar 

  123. 123

    Kane, S., Altschuler, E. L. & Kast, R. E. Crohn's disease remission on bupropion. Gastroenterology 125, 1290 (2003).

    PubMed  Google Scholar 

  124. 124

    Krane, M. K. et al. Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases. J. Am. Coll. Surg. 216, 986–996 (2013).

    PubMed  Google Scholar 

  125. 125

    Causey, M. W. et al. The impact of obesity on outcomes following major surgery for Crohn's disease: an American College of Surgeons National Surgical Quality Improvement Program assessment. Dis. Colon Rectum 54, 1488–1495 (2011).

    PubMed  Google Scholar 

Download references


S.S. is supported by the NIH/National Library of Medicine training grant T15LM011271, the American College of Gastroenterology Junior Faculty Development Award and the Crohn's and Colitis Foundation of American Career Development Award. P.S.D. is supported by the National Institute of Diabetes and Digestive and Kidney Diseases training grant 5T32DK007202. A.Z. has received support from NIH K08 DK102902, the American Association for the Study of Liver Diseases Liver Scholar Award, and the American Gastroenterological Association Microbiome Junior Investigator Research Award. The Authors thank L. J. Prokop, Senior Medical Librarian at Mayo Clinic, Rochester, USA, who assisted with a systematic literature review on this topic.

Author information




S.S. and P.S.D. researched data for the article. S.S., P.S.D., A.Z., S.R. and W.J.S. substantially contributed to the discussion of content for the article. S.S. and P.S.D. wrote the article, and all authors contributed equally to reviewing and editing of the manuscript before submission.

Corresponding author

Correspondence to Siddharth Singh.

Ethics declarations

Competing interests

W.J.S. has received consulting fees from Abbvie, Janssen Biotech, Prometheus Laboratories and UCB Pharma, research grants from Abbvie, Janssen Pharmaceutical Research & Development and UCB Pharma, and payments for lectures or speakers bureau from Abbvie, Janssen Pharmaceutical Research & Development. S.S., P.S.D., A.Z. and S.R. declare no competing interests.

PowerPoint slides

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Singh, S., Dulai, P., Zarrinpar, A. et al. Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes. Nat Rev Gastroenterol Hepatol 14, 110–121 (2017). https://doi.org/10.1038/nrgastro.2016.181

Download citation

Further reading


Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing